Eczema in children: dermatologist answers your most frequently asked questions
Baby and childhood eczema causes distress to both children and parents, especially in winter. Coping with flare-ups or angry, irritated skin disrupts sleep patterns and can be very upsetting for all involved. Shedding some light into this complex condition is Dr Catherine Borysiewicz, an experienced consultant dermatologist within the NHS.
La Roche-Posay asked Mumsnet users to share their top questions to help cope with this condition. From how often to bathe a child with eczema to treating eczema during the colder months, read Dr Catherine’s advice on the best ways to care for your child's delicate skin.
4 top tips for managing eczema
Parents' most frequently asked questions about eczema in children
With the amount of handwashing at the moment, DS's hands are getting very dry. Do you recommend any soaps/handwashes that don't dry out the skin?
The whole world is washing their hands at the moment and many people are struggling with dry skin and hand eczema.
Washing with soap offers the best protection from coronavirus and it's really important to do this. I have a rule of one pump of handwash for my kids otherwise they will quite happily empty an entire bottle for one handwash!
I also have a large fragrance-free moisturiser in a pump next to the soap for them to apply once they dry their hands. A pump prevents contamination of the moisturiser.
I have a lip-licking six-year-old. Have you got any recommendations for dry lips?
Dry skin and eczema around the lips often leads to persistent lip licking, which further dies out the skin and aggravates the eczema, particularly in winter. Make sure skin is washed and dried well after meals, and apply a colourless barrier cream to the lips and surrounding skin such as cicaplast baume. This will reduce contact with saliva on the skin, support the skin barrier and reduce discomfort.
I always send my kids to school with Lipikar AP+ Stick which they can use as a lip balm. It's chunky and easy for them to apply, and doesn't tend to cause a big stick mess in their school bags.
DC has keratosis pilaris. What is the most gentle but effective treatment for children around age 10?
Keratosis pilaris is a variant of normal skin that occurs very commonly. It consists of rough bumps that are caused by small keratin plugs around hair follicle openings on the skin – usually on the upper arms and thighs, but it can also happen on the cheeks.
It tends to be worse in the winter and better in the summer. If it causes no symptoms, no specific treatment is required. You can use moisturisers alone. If the bumps are itchy or symptomatic you can try moisturisers containing urea or alpha and beta hydroxyacids to remove the dead keratin build up, giving smoother skin.
Is eczema often linked to diet? Which foods are worth excluding to try to clear it up?
There's a lot of conflicting information about the importance of diet and the link between eczema and food allergies. Eczema can be more commonly associated with food allergies, hay fever and asthma, but the reasons why this happens are not 100% understood.
Current evidence suggests that the first problem lies with an altered skin barrier – this is the ability of your skin to defend itself from allergens, irritants and infections present in our environment. It's suggested that if your child is exposed to irritants and allergens through inflamed skin, rather than in an appropriate way, the immune system can become incorrectly activated resulting in allergies.
So the best thing is to support your child’s skin barrier with regular moisturising and treating any patches of active eczema with GP prescribed treatments such as mild steroid creams. The skin requires a balanced diet to remain healthy so ensure that your child has a mix of fruit, vegetables and enough protein. Fish oils are also very beneficial – oily fish like salmon helps too.
If your child has eczema as a baby, is it something that they can 'grow out of' as they get older?
Eczema usually presents from four months to two years of age. After that it tends to gradually improve – 60% of cases settle by ten years old – and further improve during teenage years when oil production in the skin is boosted, helping to counteract some of the dryness associated with eczema-prone skin.
My daughter's eczema seems to get worse when she is ill. Why is this and what's the best strategy for managing it?
Illness is certainly a common cause of eczema flares. This can be through skin infections, but also unrelated viral illnesses that are incredibly common during childhood.
Have a treatment plan for when things start to flare – avoid soaps, increase the number of times you are applying a moisturiser and treat any active patches as directed by your GP. Try to recognise flare-ups quickly, as this will allow you to be as proactive as possible in getting on top of them.
GPs can be reluctant to prescribe steroids for children, but they can sometimes be the only solution to a flare-up. What are your views on this?
When eczema flares occur, steroid creams form a really important part of treatment. There's often a lot of anxiety from parents and GPs about the dangers of overusing steroids and the long-term consequences of this on the skin.
I want to reassure you that dermatologists will follow a ‘treatment ladder’ approach when deciding which strength steroid to recommend for eczema flares and will also give clear recommendations about how long it is safe to apply them for, as well as where they are safe to use. For example, the skin on the face and neck is thinner and more vulnerable to steroid side-effects, so a weaker steroid will be recommended for these areas.
The key is to prescribe the weakest strength steroid that is effective in treating the flare. Remember that, as a parent of a child with eczema, you are the expert in understanding your child’s skin and its response to treatments. It's important that you feedback to your GP or dermatologist about the frequency of flares, the number of days you are needing to use steroid creams, and roughly how long a tube of steroid cream will last. Treatments can then be stepped up or down as needed.
There are also newer treatment strategies available that do not involve steroids – these products are called topical immunomodulators, and will often be considered if you need to frequently apply strong steroid creams.
How often should you bathe a child with eczema?
Dermatologists recommend a daily bath for all children and adults suffering from eczema. This is to reduce the buildup of staphylococcus aureus bacteria on the skin and prevent infected eczema flares.
Try to keep the baths short (15 minutes maximum) and ensure the water is not too hot. Use a soap substitute such as LIPIKAR Syndet AP+ which will not strip important natural oils from your child’s skin. If you find it helpful, add a bath emollient to the water.
What makes the La Roche-Posay LIPIKAR skincare range different from the many other skincare options for children?
The LIPIKAR AP+ range not only helps lock moisture into your child’s dry skin, it also has ingredients that help soothe the skin and reduce itchiness.
It has a high concentration of glycerine and shea butter to help restore the skin’s natural barrier, and niacinamide to help prevent itchy skin and irritations. The formula also contains Aqua Posae Filiformis, which helps rebalance the bacteria on the skin surface to reduce the frequency of flare-ups.
Any tips on how to stop children scratching and do you have anything to help with the itch?
Eczema is incredibly itchy so it's a normal reaction for your child to scratch a lot. The problem is that the scratching will further damage the skin, and can also form a habit in your child. Dry skin is itchy, so keep skin soothed with regular moisturiser – you can never apply too much.
Treat eczema flares as guided by your GP or dermatologist with treatment creams, such as steroids, as these reduce inflammation in the skin and help with the itching. Some children benefit from the use of antihistamine and again this can be guided by your healthcare professional.
Keep itchy skin covered with long sleeves and trousers in breathable fabrics such as cotton or linen. Younger children can also have mitts (often built into baby sleeping bags) to cover their hands.
As your child gets older, try giving them soothing cool sprays or moisturising sticks such as LIPIKAR Stick AP+ to give them something to apply instead of itching. Also, remember to always keep their nails as short as possible.
My son's eczema gets much worse when he's very tired or stressed – SATs time at school is a prime example. How can I minimise the impact of stress on his eczema?
As a dermatologist, I frequently see the impact of stress on all inflammatory skin conditions – whether it's eczema, psoriasis or acne. Stress increases the body’s production of cortisol and this can aggravate all forms of inflammation in the skin. Stress will also affect your sleep patterns, which can also affect the balance of your skin. Children are under a huge amount of pressure, and exams create a perfect storm for flares in eczema.
Explaining why the skin flares to your child will increase understanding and proactive treatment, and getting them to apply more moisturisers during times of increased stress will help support a vulnerable skin barrier.
Try to keep a balance of activities during this time – give your child time to enjoy other hobbies which they find relaxing. This can also have a big impact on skin health and wellbeing. Ensure a healthy and varied diet to provide the skin with all the important ‘building blocks’ it needs – including minerals, vitamins and proteins in their meals.
What is LIPIKAR Baume AP+M and what makes it so special?
The Mumsnet Rated LIPIKAR Baume AP+M is a hydrating, soothing balm for dry, itchy skin. It’s suitable for the whole family, including newborn babies, and it can also be used on eczema-prone skin.
Best of all, it provides triple-action efficacy. This restoring balm immediately soothes the skin and provides up to 48 hours of hydration so that itching sensations caused by dry skin are reduced for long-lasting comfort.
The AP+M formula restores the skin barrier function, reducing the frequency of dry skin flare-ups, and helps to rebalance the skin microbiome.
The LIPIKAR Baume AP+M combines exclusive AP+M technology (Aqua Posae and Microresyl) with anti-irritation thermal spring water from La Roche-Posay, Niacinamide, 8% Glycerin and 20% shea butter.
La Roche-Posay is a pioneer in microbiome science, leading the way in research for nearly 10 years. The microbiome is the invisible ecosystem of bacteria on your skin, the balance of which helps to ensure good skin health. This knowledge inspired the formula of LIPIKAR Baume AP+M.
This gentle moisturising balm has been through rigorous dermatological testing to ensure it is suitable for use on even the most sensitive skin, including on newborn babies from three months onwards.
Minimalist hypoallergenic formula
The minimalist, fragrance-free formula is designed for sensitive skin and its needs. Tested and re-tested for its efficacy and mildness on sensitive skin, the formula is also hypoallergenic.
9 out of 10 UK dermatologists recommend La Roche-Posay.*
Want to try LIPIKAR Baume AP+M for yourself?
Save 25% on La Roche-Posay Baby. Available at Boots and Boots.com.
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Find out more about LIPIKAR Baume AP+M on the La Roche-Posay website.Show now
For more information about eczema in babies and children visit the NHS website.
*Survey conducted on 267 dermatologists by La Roche-Posay in the UK; July 2019